If you want to know how “practice guidelines” can cause your death, watch this 30 minute video. Dr. Amerling’s comments are entertaining and true. I think he knew when he gave this lecture that non-physicians would view it later and so he attempts to make it layman-friendly.
HMO’s, Accountable Care Organizations, Physician-Hospital-Organizations are all huge advocates of “practice guidelines.” They have to be. You see, while advocates of these alphabet killers give lip service to cost containment, what they are really after is profit maximization. The more “costs are contained” (the more care denied) the greater the net profit to the organization. This design is about the viability of the “organization” not about the viability of the patient. The Medicare goons have embraced “practice guidelines,” as well, to delay the program’s insolvency. Big hospitals love these guidelines as their payments for care are spared giant expense, resulting in much larger net profits.
Forcing these practice constraints on to an already broken system is not the answer. The premise of third party controlled payment represents a distortion whose remedy isn’t some halloween mask like practice guidelines, but a re-thinking of the premise. Without patients in control of the payment for their care, someone else will be in control of what care they receive. These practice guidelines are an attempt to “save the system” from “overutilizers,” not ensure quality of delivered care. Every patient’s disease and situation are different requiring a customized approach, formed by the interaction with that patient’s trusted physician.
Kudos to Dr. Amerling and the Association of American Physicians and Surgeons for rejecting cookbook killer medicine.
G. Keith Smith, M.D.
